Coding for Quitting

Cigarette smoking is the leading cause of preventable death according to the Centers for Disease Control and Prevention (CDC)[1].  The LEADING cause of PREVENTABLE death.  The CDC also states that cigarette smoking accounts for more than 480,000 deaths every year, or 1 of every 5 deaths.  Additionally, their statistics indicate that nearly $170 billion is spent annually in the United States[2] on medical care to treat smoking-related disease in adults.  This does not include what is spent to treat victims of secondhand smoke.

quitWhat does this have to do with coding?  Health care providers are positioned to have a positive impact on someone’s decision to quit smoking as well as their success.  The importance of encouraging patients to quit smoking led to the creation of two Current Procedural Terminology (CPT) codes just for smoking and tobacco cessation counseling.  CPT 99406 is used to report a smoking and tobacco use cessation counseling visit that lasts between three and ten minutes.  A counseling visit that lasts more than ten minutes is reported with CPT code 99407.  Either of these codes can be reported with an evaluation and management (E/M) code utilizing modifier 25 to indicate that the time spent on the E/M portion of the visit was distinctly separate from the time spent counseling for smoking and tobacco use cessation.  As with all services, there must be sufficient documentation in the medical record to support the charge for this counseling.  That documentation must include the face-to-face time, cessation techniques and resources discussed as well as planned follow up.

While encouraging people to quit smoking seems like a no-brainer, providing health care professionals with specific CPT codes to document their attempts is a huge step in the right direction for tracking the outcomes.  The combined impact of television and radio ads plus written health warnings and direct feedback from one’s healthcare provider will hopefully result in fewer smokers in the United States.

Go document those efforts.

Disclaimer: This Blog is for educational purposes only as well as to provide general information and a general understanding of the topics discussed.  The Blog should not be used as a substitute for legal advice and you are advised to seek additional information from your insurance carriers, Medicare and/or Medicaid agencies for additional criteria and regulations regarding these services.

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